Provider Demographics
NPI:1932574191
Name:FARMACIA ISLA VERDE
Entity Type:Organization
Organization Name:FARMACIA ISLA VERDE
Other - Org Name:SUPER FARMACIA ISLA VERDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-548-7559
Mailing Address - Street 1:3409 AVE ISLA VERDE
Mailing Address - Street 2:APT 602
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-4970
Mailing Address - Country:US
Mailing Address - Phone:787-548-7559
Mailing Address - Fax:
Practice Address - Street 1:1035 CALLE MAR AMARILLO MARGINAL VILLAMAR AO16
Practice Address - Street 2:ISLA VERDE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-548-7559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F-34073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy